Healthcare Provider Details

I. General information

NPI: 1578494589
Provider Name (Legal Business Name): MAHDI ALMOTHAFER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50682 BELMONT CT
CANTON MI
48187-4441
US

IV. Provider business mailing address

50682 BELMONT CT
CANTON MI
48187-4441
US

V. Phone/Fax

Practice location:
  • Phone: 313-896-8419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: